Report on Improving Quality at the End of Life Presented to Pennsylvania Governor Rendell

HARRISBURG – Department of Aging Secretary Nora Dowd Eisenhower today unveiled a series of policy recommendations that are designed to improve the quality of life for seriously ill and dying Pennsylvanians, as well as their families and caregivers.

The recommendations are contained in a report to Gov. Edward G. Rendell by the Task Force for Quality at the End of Life, a diverse panel of experts assembled at the Governor’s direction. The Department of Aging coordinated the task force’s work.

“The recommendations offered by this report can help our health care and long-term living systems to better respond to the needs of individuals facing the end of life,” said Eisenhower. “Although it will never be easy, there are many ways in which we can help to make this final transition less difficult for Pennsylvanians.”

Eisenhower said the task force outlined a series of challenges that exist in Pennsylvania today. Most Pennsylvania residents do not have a living will, which guides family members and doctors on the level of life-sustaining treatment that individuals wish to receive. Nearly half of all deaths in Pennsylvania occur in hospitals, despite the fact that nine-out-of-10 people say they would prefer to die at home. Less than one percent of health care providers are certified in palliative care.

Only about two-in-10 Pennsylvania hospitals report having hospice programs.

“When we consider that 27 percent of Medicare expenditures pay for health care during the last year of life, it would seem prudent to invest in systems of care that make efficient use of our limited resources, while maintaining patient preference for care,” Eisenhower said.

Priority recommendations of the task force include:
– Adopting and adhering to quality standards. Health care facilities around the state should adopt and adhere to the national standards set forth by the National Consensus Project and the National Quality Forum.
– Designing and implementing demonstration projects. Public/private partnerships should test new and innovative delivery and reimbursement systems to improve quality and continuity of care across health care delivery settings including home-based care.
– Documenting treatment preferences. In accordance with Act 169, the state should explore ways to adopt a tool to document people’s treatment preferences consistently across care settings.
– Improving education through licensing/accrediting/regulatory bodies and professional organizations. The core elements and principles of palliative care should be incorporated into health professions curricula and enforced by appropriate regulatory, accrediting, and professional licensing bodies.
– Engaging underserved communities. To meet the palliative care needs of underserved populations, such as ethnic minorities, individuals with disabilities, and children, members and advocates of these communities should be actively engaged in needs assessment and program design activities.
– Raising public awareness. A statewide public awareness and education campaign should be undertaken to improve Pennsylvanians’ access to palliative care and end-of-life services, to help them become more informed about palliative care, and to encourage planning around end- of-life issues.

Eisenhower noted how certain recommendations contained in the report coincide with an important component of the Governor’s recently announced Prescription for Pennsylvania health care reform initiative.

“Governor Rendell’s Prescription for Pennsylvania suggests, among other things, that Pennsylvania should increase the use of palliative care and pain management specialists throughout the health care system, and also expand the use of hospice services for those in the end stage of life, including children. This report wholeheartedly concurs with that approach,” she said.

Eisenhower said the report also offers a solid framework that will help policymakers and legislators consider a broad range of options to improve end- of-life care and family supports.

“Enhancing the quality of life, including end-of-life experiences, for all Pennsylvanians is a challenge of increasing urgency,” Eisenhower said. “By involving everyone with a stake in this process – medical professionals, educators, government policymakers, advocates, and the public – we can address these most basic conditions of human life with intelligence and compassion.”

Task force members who participated in the news conference included:
– Dr. David Barnard, director & professor of medicine, Institute to Enhance Palliative Care, University of Pittsburgh
– Steve Suroviec, executive director, Arc of Pennsylvania, Harrisburg
– Darlene Sampson, executive director, Pennsylvania Council on Aging
– Dene Liott, consumer advocate, Pottstown
– Nancy Zionts, Vice President of Program & Planning, Jewish health Care Foundation, Pittsburgh

The task force report, “Improving End-of-Life Experiences for Pennsylvanians,” and related background documents are available at the Department of Aging’s Web site at www.aging.state.pa.us.

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